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Cognitive Behavorial Therapy for Back Pain

What Happens in a CBT Session?


Updated January 27, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

If you live with chronic neck or back pain, the way you have adapted to it may or may not be working in your favor. For example, have you spent time identifying the activities, relationships or even thoughts that make your pain worse? Have you examined any attitudes you may be holding that get in the way of your full commitment to or participation in the pain management plan your doctor gave you (for example, doing prescribed back exercises daily)?

It is possible that your attitude may be making your pain worse, or at least more difficult to live with.

Research strongly suggests that addressing perceptions, attitudes, beliefs and other personality factors (especially those related to your neck or back condition), along with the way they affect your life, may be worth the effort. In medical parlance, these phenomena are known as psychosocial factors.

A review of medical studies focusing on the role psychosocial factors play in management of chronic pain found that our beliefs, attitudes, mood states and social lives tend to interact with our pain behavior. When they do, the result is often distorted beliefs about one’s self, one’s experience and/or the world in which one lives.

Related: Is Chiropractic For You?

Cognitive Behavioral Therapy

Cognitive behavioral therapy is an approach to psychotherapy that teaches you how to identify distorted beliefs or perceptions (i.e. the “factors” and phenomena mentioned above) that could be complicating your recovery. By using techniques designed specifically to help you examine and modify your thinking, a cognitive behavioral therapist may be able to assist you in bringing these distortions back in line with reality. In turn, this may help you reinforce behaviors that can help you recover from and/or manage your pain. Cognitive behavioral therapy may also help discourage the distortions that make your life (and coping with your pain) more difficult.

Related: Chronic Back Pain and Depression

For example, a common activity in a cognitive behavioral therapy session is testing the assumptions you make regarding your life, your relationship with others and/or your relationship with the world around you. Your therapist might ask you to explain or describe a fear you have -– let’s say a fear that moving your body may increase your pain and lead to a fall. And let's say that because of this fear, you say no to a number of opportunities to socialize, spend time with family members and/or advance your career.

Once you and your therapist have decided on a specific belief to address during the session, she may then ask you a series of questions about the belief.

Answering the questions may help you reevaluate your priorities. You may, for instance, believe that falling would be too embarrassing and people who witnessed your falling would laugh at you. But the goal of therapy is to help you separate the fears that are grounded and point to the need for some advance planning from those that may not matter to you at all should they occur. It's true that falling may exacerbate your pain or condition, and that’s something you should probably consider before taking too many physical risks. But let’s face it, people in public places tend to be focused on themselves. They generally won’t notice what’s going on with you, even if you do fall. And of the people who do notice, I’d be willing to wager that most would be more interested in making sure you're okay than in making fun of you.

So if you are game to look at the way in which your thinking contributes to your pain, a few sessions of cognitive behavioral therapy may be just the ticket.


Innes, Stanley, I. Psychosocial factors and their role in chronic pain: A brief review of development and current status. Review. Chiropractic and Osteopathy April 2005. http://www.chiroandosteo.com/content/12/1/16

Cognitive Behavior Therapy. Beck Institute blog. Accessed July 2012. http://www.beckinstitute.org/what-is-cognitive-behavioral-therapy/

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